Feasibility of Laparoscopic Total Mesorectal Excision with Extended Lateral Pelvic Lymph Node Dissection for Advanced Lower Rectal Cancer after Preoperative Chemoradiotherapy

Atsushi Ogura, Takashi Akiyoshi, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno, Hiroya Kuroyanagi
World Journal of Surgery 2017, 41 (3): 868-875

BACKGROUND: The feasibility of additional lateral pelvic lymph node dissection (LPLND) compared with total mesorectal excision (TME) alone in patients treated with preoperative chemoradiotherapy (CRT) is controversial, especially in laparoscopic surgery. This study was performed to evaluate the feasibility of adding laparoscopic LPLND to TME in patients with advanced lower rectal cancer and swollen LPLNs treated with preoperative CRT.

METHODS: We reviewed 327 patients with lower rectal cancer without distant metastasis who underwent preoperative CRT followed by laparoscopic TME. Laparoscopic LPLND was added in patients with swollen LPLNs before CRT. Outcomes were compared between patients with (n = 107) and without (n = 220) LPLND.

RESULTS: LPLN metastasis was found in 26 patients (24.3 %) in the LPLND group. The operation time was significantly longer, and total blood loss was significantly greater in the LPLND than TME group (461 vs. 298 min and 115 vs. 30 mL, respectively; P < 0.0001). The major complication rate was similar in the LPLND and TME groups (9.3 vs. 5.5 %, respectively; P = 0.188), and there were no conversions to open surgery. The LPLND and TME groups also showed a similar 3-year relapse-free survival rate (84.7 vs. 82.0 %, respectively; P = 0.536) and local recurrence rate (3.2 vs. 5.2 %, respectively; P = 0.569) despite significantly more patients with pathological lymph node metastasis in the LPLND than TME group (37.4 vs. 22.3 %, respectively; P < 0.0001).

CONCLUSIONS: Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"